Drug and Alcohol Findings home page in a new window EFFECTIVENESS BANK ABSTRACT BULLETIN 15 March 2011

The entries below summarise documents collected by Drug and Alcohol Findings. Citation here does not imply that these documents are particularly relevant to Britain and of particular merit, though they may well be both. The original documents were not published by Findings; click on the Titles to obtain copies. Free reprints may also be available from the authors; if displayed, click Request reprint to send or adapt the pre-prepared e-mail message. The Summary is intended to convey the findings and views expressed in the study. Below may be comments from Drug and Alcohol Findings. Links to source documents are in blue. Hover mouse over orange text for explanatory notes.

If you have not found what you want you could:
● Try a subject or free text search instead. Searches include bulletin entries and all other documents on this site.
● Try browsing other bulletins or back issues of the magazine.
● Try the information services provided by Alcohol Concern, Alcohol Research UK, or DrugScope (opens new window).
● Documents are regularly added. Use the e-mail update service to monitor additions.
● Return to the home page.

Open home page. Get free e-mail alerts about new studies. Search studies by topic or free text


Intensive testing for long-term recovery

Influential US researchers (see first entry in bulletin) believe that three US programmes show that many seriously dependent individuals stop using if non-use is enforced through intensive monitoring and swift, certain but not necessarily severe consequences. A distinctive feature of these programmes is the strong leverage used to sanction substance use and to reward abstinence: in physician health programmes, removal from practice and ultimately the loss of medical license versus continuing to practice in a prestigious and well paid profession; in the HOPE programme for offenders on probation and the 24/7 Sobriety programme for drink-drive defendants, immediate brief imprisonment versus freedom. Results are said to challenge the view that relapse is an essential feature of substance dependence and to demonstrate that the key to long-term success lies in sustained changes in the environment in which decisions to use and not use are made: if this rewards substance use, use is likely to continue, but the drinking and drug use of many seriously dependent individuals stops if the environment not only prohibits use, but enforces this through intensive monitoring with meaningful consequences attached to compliance and non-compliance. All the entries in this bulletin relate to the three programmes said in the first entry to exemplify a new paradigm for long-term recovery.

Intensive monitoring offers new paradigm for long-term recovery ...

Remarkable success rates of physician health programmes ...

Drug using offenders tested intensively do well without treatment ...

US drink-drivers respond to threat of imprisonment for substance use ...

99% tests alcohol-free among monitored drink-drive defendants ...

Intensive testing and sanctions cut drink-drive re-offending ...

Originator explains drink-drive testing and sanctions programme ...


A new paradigm for long-term recovery.

DuPont R.L., Humphreys K.
Substance Abuse: 2011, 32, p. 1–6.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr DuPont at bobdupont@aol.com.

On the basis of three innovative US programmes for offenders or doctors with substance use problems, this analysis concludes that many seriously dependent individuals stop using if non-use is enforced through intensive monitoring and swift, certain but not necessarily severe consequences.

Summary Typical US substance use treatment amounts to a few weeks of outpatient counselling. Given that these disorders are characterised by lifelong risk of relapse, it is not surprising that many treatments yield suboptimal outcomes for many patients. Interventions that work:
• last months or years rather than weeks;
• carefully monitor use of alcohol or other drugs of abuse;
• impose swift, certain, and meaningful consequences for use and non-use of substances.

This article profiles three innovative care management programmes with these characteristics: physician health programmes, and two therapeutic jurisprudence programmes – South Dakota's 24/7 Sobriety Project and HOPE probation. These actively and intensively manage the environments in which people with substance use disorders make decisions to use or not to use.

Physician health programmes

Physician health programmes offer drug- and alcohol-using physicians the opportunity, motivation, and support to achieve long-term recovery, using all three strategies in the new paradigm: monitoring, treatment, and 12-step programmes. In return, physicians sign contracts, typically for five years, to adhere to the programme, including completing treatment and submitting to frequent random drug testing to ensure abstinence. Each working day physicians phone or log-in to find out if they must report for testing. All are expected to be active in 12-step or similar community support programmes. Substance use or any other evidence of non-compliance typically results in immediate removal from medical practice to arrange extended treatment followed by more intensive monitoring.

A chart review study of a single episode of physician health programme care involving 904 physicians showed that only 0.5% of tests on this high risk, substance abusing population were positive for alcohol or other drugs of abuse.

Hawaii Opportunity Probation with Enforcement

The Hawaii Opportunity Probation with Enforcement (HOPE) programme manages convicted offenders, most of whom are identified as likely to violate community supervision requirements. Their most common drug problem is smoked crystal methamphetamine. A judge tells offenders about the rules, including that they are subject to intensive random testing similar to that used by physician health programmes. Violations of probation, including any drug or alcohol use, missed drug tests, or missed appointments, are met with certain, swift but brief imprisonment.

When asked at the start of the programme, only a few HOPE probationers choose treatment to help them meet the abstinence requirement. The remainder are simply monitored unless they violate probation; most are then referred to treatment. About 85% complete the programme (which can last up to six years) without treatment.

In a 12-month period, 61% of HOPE offenders had no positive drug tests and fewer than 5% had four or more. A study compared probationers randomly assigned to HOPE or to standard probation. After a year, HOPE probationers were 55% less likely to be arrested for a new crime, 72% less likely to use drugs, 61% less likely to miss supervisory appointments, 53% less likely to have their probation revoked, and were sentenced to 48% fewer days of prison.

South Dakota's 24/7 Sobriety project

South Dakota's 24/7 Sobriety programme serves drink-driving offenders, nearly half of whom have three or more drink-driving convictions. Participants must undergo twice-daily alcohol breath tests at a local police station or wear continuous transdermal alcohol monitoring bracelets and are also subject to regular drug urinalyses or must wear drug detection patches. Positive tests result in immediate brief imprisonment and missed appointments in immediate issuance of arrest warrants. Results are impressive: over 90% of all types of tests are negative, for alcohol breath tests, virtually all. Post-programme recidivism among twice-daily tested offenders is considerably lower than among comparison offenders.

Conclusions

A distinctive feature of these three interventions is the strong leverage used to sanction substance use and to reward abstinence: in physician health programmes, removal from practice and ultimately the loss of medical license versus continuing to practice in a prestigious and well paid profession; in HOPE and 24/7 Sobriety, immediate brief imprisonment versus freedom.

Mandatory abstinence in this new paradigm contrasts sharply with programmes which mandate treatment but do not impose meaningful consequences for substance use. The two offender programmes contrast with common approaches where consequences for non-compliance, including substance use, are delayed, uncertain, and, when applied often after many violations, draconian. This new way of managing substance use patients challenges the view that relapse is an essential feature of their disorder, shifts the focus away from finding new biological treatments, and shows that the key to long-term success lies in sustained changes in the environment in which decisions to use and not use are made. If this passively or actively rewards substance use, use is likely to continue, but the drinking and drug use of many – not all – seriously dependent individuals stops if the environment not only prohibits use, but enforces this with intensive monitoring and swift, certain but not necessarily severe consequences.


Findings logo commentary For Findings entries on the three programmes mentioned in the featured article see:
Setting the standard for recovery: physicians' health programs
Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE
Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?
Analysis of South Dakota 24-7 Sobriety program data
South Dakota 24/7 Sobriety Program evaluation findings report
The 24/7 Sobriety project

Last revised 14 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

South Dakota 24/7 Sobriety program evaluation findings report STUDY 2010

The 24/7 Sobriety Project STUDY 2009

Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders? STUDY 2010

Analysis of South Dakota 24-7 Sobriety program data STUDY 2007

Setting the standard for recovery: physicians' health programs STUDY 2009

Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE STUDY 2009

Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts REVIEW 2012

Motivational arm twisting: contradiction in terms? REVIEW 2006



Setting the standard for recovery: physicians' health programs.

DuPont R.L., McLellan A.T., White W.L. et al.
Journal of Substance Abuse Treatment: 2009, 36, p. 159–171.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr McLellan at TMcLellan@tresearch.org. You could also try this alternative source.

US physician health programmes demonstrate that long-term intensive monitoring of substance use allied with swift and certain sanctions and abstinence-based mutual aid and treatment can enable seriously dependent individuals to stop using psychoactive substances.

Summary Physician health programmes offer drug- and alcohol-using physicians the opportunity, motivation, and support to achieve long-term recovery, using monitoring through drug and alcohol testing, treatment, and 12-step programmes. In return, physicians sign contracts, typically for five years, to adhere to the programme, including completing treatment and submitting to frequent random drug testing to ensure abstinence. Each working day physicians phone or log-in to find out if they must report for testing. Substance use or any other evidence of non-compliance typically results in immediate removal from medical practice to arrange extended treatment followed by more intensive monitoring.

A sample of 904 physicians consecutively admitted to 16 state physician health programmes was studied for five years or longer to characterise the outcomes of this episode of care and to explore elements of these programmes which could improve the care of other addicted populations. The study consisted of two phases: the first characterised the programmes and their systems of care management, while the second described the outcomes of the study sample as revealed in programme records.

Remarkably, 78% of participants had no positive test for either alcohol or drugs over the five-year period of intensive monitoring. Overall, the positive drug testing rate was 0.54%, meaning that an average of about 1 in 200 samples was positive, even with the extended screens and the random testing used for this monitoring. At post-treatment follow-up, 72% of the physicians were continuing to practice medicine. Of the 904, 19% had a relapse episode and were reported to their licensing boards. However, only 22% of these had any evidence of a second relapse, indicating that intensified treatment and monitoring had generally reinstated remission.

Implications for addiction treatment generally

This success rate directly contradicts the common misperception that relapse is inevitable and common among substance use patients. Rather than being a defining characteristic of addiction, 'inevitable relapse' may be a defining characteristic of the acute care model of biopsychosocial stabilisation, which offers an opportunity for recovery initiation but lacks the ingredients needed to achieve recovery maintenance. If the key ingredients of physician health programmes – particularly ongoing monitoring for this chronic illness linked to meaningful consequences – were universally available, we might find that relapse was far from inevitable and that addiction careers could be significantly shortened and stable recovery careers extended.

Six key elements of the programmes are worthy of consideration for wider dissemination in substance abuse treatment.
1. The contingency management aspects For enrolled physicians there are both significant positive (continued ability to practice medicine; reduction of pending charges against them) and significant negative consequences (loss of license, professional disgrace) from compliance or non-compliance with programme treatment and monitoring requirements.
2. Frequent random drug testing Drug testing is seldom used in substance abuse follow-up for the general population and when used, the results are seldom linked to meaningful consequences. Drug testing is never used for such long periods or with the intensity that typifies physician health programmes. Recovering physicians frequently report that testing is a powerful motivator, and it may be the programmes' most effective component.
3. Tight linkage with 12-step programmes and with the abstinence standard espoused by these fellowships Physician health programmes require abstinence from alcohol and all non-medical use of mood-altering drugs. Research has repeatedly demonstrated the efficacy of the 12-step approach for physicians with substance use disorders.
4. Active management of relapses by intensified treatment and monitoring Relapses do not typically lead to discharge from the programme. Instead, they routinely lead to intensive re-evaluation of treatment plans and implementation of additional care.
5. A continuing care approach Treatment, support, and monitoring in traditional addiction programmes lasts 30 to 90 days. There are many novel and effective ways to extend formal care, including telephone- or internet-based monitoring and support and regular home visits. Physician health programmes have formalised this element of sustained continuity of care and focused much of their professional resources on sustaining therapeutic contact over five years or longer.
6. Focus on lifelong recovery Physician health programmes rarely see achieving abstinence from the use of alcohol and drugs of abuse as sufficient care. Rather, physicians are supported and encouraged to significantly improve the quality of their lifestyles, both in their personal lives and in their practice of medicine.


Findings logo commentary For related Findings entries on physician health programmes and similar testing-based programmes see:
A new paradigm for long-term recovery
Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE
Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?
Analysis of South Dakota 24-7 Sobriety program data
South Dakota 24/7 Sobriety Program evaluation findings report
The 24/7 Sobriety Project

Last revised 14 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

A new paradigm for long-term recovery REVIEW 2011

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

South Dakota 24/7 Sobriety program evaluation findings report STUDY 2010

Analysis of South Dakota 24-7 Sobriety program data STUDY 2007

Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders? STUDY 2010

The 24/7 Sobriety Project STUDY 2009

Improving 24-month abstinence and employment outcomes for substance-dependent women receiving Temporary Assistance For Needy Families with intensive case management STUDY 2009

Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE STUDY 2009

Effective services for substance misuse and homelessness in Scotland: evidence from an international review REVIEW 2008



Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE.

Hawken A., Kleiman M.
Report submitted to the US Department of Justice, 2009.
Unable to obtain a copy by clicking title? Try this alternative source.

Intensive testing allied with swift and certain but not severe sanctions for non-compliance dramatically curbed drug use, prison time and re-arrest rates among a high risk group of drug using US offenders; most did not need treatment to help them comply with the court orders.

Summary The rates of successful completion of probation and parole have remained stable – at levels that few consider satisfactory (roughly one-third for parole, roughly three-fifths for felony probation) – in spite of many local, state, and federal initiatives to improve offender outcomes, including diversion-to-treatment programmes. The robustness of these failure rates suggests a need for an offender-management and service-delivery approach which goes beyond the status quo, particularly for drug-involved offenders.

This report describes an evaluation of a community supervision strategy called HOPE (Hawaii Opportunity Probation with Enforcement) for substance abusing probationers. HOPE began as a pilot in October 2004 and has expanded to more than 1500 participants, about one out of six felony probationers on Oahu.

HOPE relies on a mandate to abstain from illicit drugs, backed by swift and certain sanctions and preceded by a clear and direct warning. Under HOPE, offenders are sentenced to brief jail stays (typically only a few days in jail) for each violation of the terms of their probation; continued violations result in lengthier sentences. Unlike most diversion programmes and drug courts, it does not attempt to impose drug treatment on every participant. Under HOPE, probationers are sentenced to drug treatment only if they continue to test positive for drug use, or if they request a treatment referral. HOPE is distinct from drug courts in economising on treatment and court resources (probationers appear before a judge only when a violation is detected).

HOPE's goals are reductions in drug use, crimes, and incarceration. Those goals were shown to have been achieved, both in the initial pilot programme among high-risk probationers, and in the randomised controlled trial among general-population probationers, for which probationers assigned to HOPE were compared to probationers assigned to probation-as-usual. In drug tests conducted during the three months prior to their assignment to HOPE, the average HOPE offender tested positive 53% of the time compared to 22% for comparison offenders. HOPE caused a reversal: after being placed on the programme, the HOPE group become much less likely to test positive than the comparison group. After being warned, just 10% of all HOPE offenders had at least a further three positive tests. Thus HOPE identified a minority of probationers who did not desist from drug use under sanctions pressure alone – a kind of 'behavioural triage'.

Probationers assigned to HOPE also had large reductions in missed appointments, and were dramatically less likely than comparison offenders to be arrested during follow-up at three months, six months, and 12 months. They averaged approximately the same number of days in jail for probation violations, serving more but shorter terms, but spent much less time in prison because HOPE probationers were significantly less likely to be revoked from probation.

HOPE was implemented largely as intended. Sanctions were delivered swiftly and with certainty; there was variation across judges in the sanction 'dose' (the length of the jail sentence), but that variation diminished after judges learnt that subsequent violation rates proved unrelated to the length of the sentence. The original inconsistency among judges occasioned some discontent among probation officers and probationers, but overall they and defence lawyers were enthusiastic about the programme. Prosecutors and court employees were less pleased, court staff reporting increased workloads.


Findings logo commentary For related Findings entries on HOPE and similar testing-based programmes see:
A new paradigm for long-term recovery
Setting the standard for recovery: physicians' health programs
Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?
Analysis of South Dakota 24-7 Sobriety program data
South Dakota 24/7 Sobriety Program evaluation findings report
The 24/7 Sobriety Project

Last revised 14 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

A new paradigm for long-term recovery REVIEW 2011

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

Criminal justice responses to drug related crime in Scotland STUDY 2013

The 24/7 Sobriety Project STUDY 2009

South Dakota 24/7 Sobriety program evaluation findings report STUDY 2010

Review of the Glasgow & Fife drug courts STUDY 2009

Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders? STUDY 2010

Adaptive programming improves outcomes in drug court: an experimental trial STUDY 2012

Analysis of South Dakota 24-7 Sobriety program data STUDY 2007



Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?

Caulkins J.P., DuPont R.L.
Addiction: 2010, 105, p. 575–577.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Caulkins at caulkins@andrew.cmu.edu.

South Dakota appears to have achieved impressive results not by treating repeat drink-driving offenders but by requiring abstinence and enforcing this via frequent testing and the threat of immediate brief imprisonment; perhaps intensive intervention can be reserved for the few who do not comply.

Summary Unusually the US state of South Dakota has required drink-driving offenders to stop drinking rather than to stop driving. The initiative has not been evaluated scientifically, but traffic fatalities involving alcohol impairment dropped from 71 in 2004 to 34 in 2008, and some have suggested there have been favourable effects on other alcohol-associated crimes such as domestic violence. South Dakota's 24/7 Sobriety program began in the 1980s when one rural county required repeat drink-driving arrestees to submit to twice-daily (7–9am and 7–9pm) breath testing as a condition of bail. Failed tests constituted a violation of bail bond terms and were punishable by immediate 24-hour imprisonment; missed tests led to an arrest warrant.

Legislation extended 24/7 Sobriety to include illegal drugs and, beyond impaired driving, to be a possible condition of pre-trial release, probation or parole, suspended sentence and returning abused or neglected children to their parents.

Four testing modalities are used:
• twice-daily breath testing for alcohol;
• ankle bracelets that monitor alcohol consumption continuously with daily remote electronic reporting;
• twice-weekly urine testing for drugs; and
• sweat patches for drug monitoring (worn for 7–10 days and mailed in).
Random drug testing was added to alcohol testing to discourage substitution.

Reported compliance rates are impressive. Roughly two thirds subject to twice-daily testing never had a single positive or missed test and 94% had just one or two. Similarly, 78% wearing ankle bracelets were fully compliant.

24/7 Sobriety's success is striking and may be seen as at odds with the dominant understanding of addiction as a chronic relapsing brain disorder. The programme is all sticks and no carrots. Participants were free to seek treatment, and presumably some did. However, the programme did not include treatment, treatment referral or any treatment requirement. Sanctions are modest but immediate and certain. Aggressive monitoring of the kind implemented by 24/7 Sobriety may achieve a kind of 'behavioural triage' in the criminal justice system: most offenders become abstinent when their environment becomes intolerant to continued use, while the minority who do not 'self-select' for more intensive interventions. Perhaps the objective should be intensive treatment for a few, rather than (inevitably somewhat mediocre) treatment for all.


Findings logo commentary For related Findings entries on 24/7 Sobriety and similar testing-based programmes see:
A new paradigm for long-term recovery
Setting the standard for recovery: physicians' health programs
Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE
Analysis of South Dakota 24-7 Sobriety program data
South Dakota 24/7 Sobriety Program evaluation findings report
The 24/7 Sobriety project

Last revised 15 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

A new paradigm for long-term recovery REVIEW 2011

The 24/7 Sobriety Project STUDY 2009

South Dakota 24/7 Sobriety program evaluation findings report STUDY 2010

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

Analysis of South Dakota 24-7 Sobriety program data STUDY 2007

The effect on reconviction of an intervention for drink-driving offenders in the community STUDY 2012

Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE STUDY 2009

Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts REVIEW 2012

Alcohol and drug screening of occupational drivers for preventing injury REVIEW 2009



Analysis of South Dakota 24-7 Sobriety program data.

Mountain Plains Evaluation, LLC.
Mountain Plains Evaluation, LLC, 2007.

Analysis of data routinely collected by South Dakota's 24/7 Sobriety project reveals that offenders test alcohol-free at 99% of the scheduled twice-daily tests intended to enforce abstinence via the threat of a bail violation leading to immediate brief imprisonment.

Summary The South Dakota 24/7 Sobriety programme requires repeat drink-driving arrestees to submit to twice-daily (7–9am and 7–9pm) alcohol testing as a condition of bail. Failed tests constitute a violation of bail bond terms and are punishable by immediate 24-hour imprisonment; missed tests lead to an arrest warrant. The data included in this analysis was exported from the project's web-based management information system maintained by the Office of the Attorney General.

Data provided for analysis included all 1074 participants with a drink-driving offence collected via the system from inception of the programme through to the end of November 2006. About half the defendants had at least three drink-driving convictions. All were tested twice a day for on average 111 days. Testing results were available for 1021 participants. They had showed up and completed 165,456 tests out of 166,222 scheduled tests. Missed or 'No Showed' tests occurred 766 times of which 407 were excused leaving only 359 for which a documented excuse was not recorded. Therefore, participants are showing up and being tested or have excused missed tests for over 99.8% of the scheduled tests.

Of the tests taken, participants passed (ie, were alcohol-free) 165,105 (99.3% of the scheduled tests) and failed 534. After review of the data, it is believed that the actual number of failed tests is lower because numerous test failures appear to have been entered more than once in to the database. From a review of the records, it appears that when individuals fail and consequences are imposed, subsequent compliance increases. In summary, individuals are overwhelmingly showing up and being tested, and for individuals who do not show up or who blow a positive test, consequences are being imposed. Therefore one can conclude that the overall result of the programme is a reduction in drinking and driving among the participants.


Findings logo commentary For related Findings entries on 24/7 Sobriety and similar testing-based programmes see:
A new paradigm for long-term recovery
Setting the standard for recovery: physicians' health programs
Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE
Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?
South Dakota 24/7 Sobriety Program evaluation findings report
The 24/7 Sobriety Project

Last revised 12 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

A new paradigm for long-term recovery REVIEW 2011

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

South Dakota 24/7 Sobriety program evaluation findings report STUDY 2010

Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders? STUDY 2010

The 24/7 Sobriety Project STUDY 2009

The effect on reconviction of an intervention for drink-driving offenders in the community STUDY 2012

Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE STUDY 2009

Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts REVIEW 2012

Motivational arm twisting: contradiction in terms? REVIEW 2006



South Dakota 24/7 Sobriety program evaluation findings report.

Loudenburg R., Drube G., Leonardson G.
Mountain Plains Evaluation, LLC, 2010.

Drink-driving offenders on South Dakota's 24/7 Sobriety project test alcohol-free at over 99% of the twice-daily breath tests intended to enforce abstinence via the threat of immediate brief imprisonment, and subsequent recidivism is lower than among other drink-driving offenders in the state.

Summary The South Dakota 24/7 Sobriety programme requires repeat drink-driving arrestees to submit to twice-daily (7–9am and 7–9pm) alcohol testing as a condition of bail. A participant's bond, parole or probation may be immediately revoked if they miss a scheduled test, or if the test indicates they have drunk alcohol. In many cases the infraction will result in immediate 24-hour imprisonment; missed tests lead to an arrest warrant. The data included in this analysis derived from the project's web-based management information system maintained by the Office of the Attorney General which records substance use test results, plus offender data maintained by the Unified Judicial System (UJS) which permits an assessment of recidivism compared to drink-driving offenders not sentenced to 24/7 Sobriety.

This data shows very promising results. Of almost 820,000 recorded twice-daily alcohol breath tests on 24/7 participants from 2005 to early 2010, just 0.06% were recorded as failures. Almost 55% of the 4009 24/7 Sobriety programme participants in the sample did not fail a test, and only 9% had more than three failures during a testing period which averaged about 120 days. Recidivism among the same sample was consistently lower than among a comparison group of South Dakota drink-driving offenders, suggesting that the programme has a sustained impact on repeat drink-driving offending after programme completion. Notably, 14% of two-time offenders not on the programme committed another drink-driving offence within three years, but only 7% of 24/7 Sobriety participants, a statistically significant difference. Small sample sizes are the major obstacle to drawing further statistical conclusions.


Findings logo commentary For related Findings entries on 24/7 Sobriety and similar testing-based programmes see:
A new paradigm for long-term recovery
Setting the standard for recovery: physicians' health programs
Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE
Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?
Analysis of South Dakota 24-7 Sobriety program data
The 24/7 Sobriety project

Last revised 14 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

A new paradigm for long-term recovery REVIEW 2011

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders? STUDY 2010

The 24/7 Sobriety Project STUDY 2009

Analysis of South Dakota 24-7 Sobriety program data STUDY 2007

Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE STUDY 2009

The effect on reconviction of an intervention for drink-driving offenders in the community STUDY 2012

Assessing the effectiveness of drug courts on recidivism: a meta-analytic review of traditional and non-traditional drug courts REVIEW 2012

Alcohol and drug screening of occupational drivers for preventing injury REVIEW 2009



The 24/7 Sobriety Project.

Long L.
Unpublished.

An account from the its originator of the genesis, working and impressive impacts of South Dakota's 24/7 Sobriety project; rather than treating repeat drink-driving offenders, the project enforces abstinence via frequent testing and the threat of immediate brief imprisonment.

Summary The usual message to drunk drivers is, "if you don't quit drinking and driving, we will make you quit driving." Enforcement efforts are geared to keeping drunk drivers off the road. This is done through license suspensions or revocation, and incarceration for repeat violations. Due to inadequate supervision, probation is reliant on the offender's cooperation, and many continue to drive illegally and are held to account only when they are re-arrested. The system is simply not designed to address the underlying problem of alcohol and illegal drug dependence or addiction. In contrast, the message of South Dakota's 24/7 Sobriety programme to drunk drivers is, "If you don't quit drinking and driving, we will make you quit drinking." Although not a substitute for drug and alcohol treatment, the project attacks alcohol dependence and addiction in a new and more direct way.

At the request of the project, judges imposed a special set of bond conditions on the target group. The conditions were:
• defendants must completely abstain from the consumption of alcohol;
• defendants must report to a test site (typically the sheriff's office) every morning and every evening at 7am/pm and submit to a test of breath, blood or other bodily substance for the consumption of alcohol.

Defendants who tested positive were immediately incarcerated for violating the bond condition. Bench warrants were issued for defendants who failed to report to the test site on time. All defendants who violated a bond condition were incarcerated for 24 hours before making a court appearance where the same conditions were imposed. In counties lacking the personnel to test twice a day, defendants were issued SCRAM (Secure Continuance Remote Alcohol Monitoring) bracelets to monitor their alcohol and drug use.

The pilot programme testers saw that regular testing and accountability could keep chronic drink driving defendants sober for months at a time. But they also saw that some defendants were using marijuana, cocaine or methamphetamine as a substitute for alcohol. This prompted the implementation of a urinalysis testing programme to randomly test for illegal drugs. The next challenge was to extend drug testing to rural areas lacking the personnel to administer tests. The simple answer was a sweat patch. Once judges in pilot counties saw the effectiveness of the programme on chronic drunk drivers, they decided to extend it to defendants arrested for non-driving alcohol-related offenses.

By December 2006, the pilot project had processed over 1000 drink driving defendants. Two-thirds tested for an average of 111 days were 100% compliant. At present, over 1800 defendants are tested each day and nearly 11,000 defendants have been tested to date. More than 99% of participating defendants report on time and test clean. The 24/7 Sobriety Project has demonstrated short-term success. Hundreds of participants who had been drinking for decades now enjoy sobriety.

There are other encouraging signs. South Dakota lost 191 people in traffic fatalities in 2006. In 2007, the traffic death toll dropped to 146 and in 2008 to 121. In 2006, 67 South Dakotans died in alcohol-impaired auto crashes. That number dropped to 45 in 2007 and to 25 in 2008. The expansion of the 24/7 Sobriety project was identified as one of several reasons for these declines. The project started in response to South Dakota's increasing prison population. Between 1996 and 2006 the prison population grew by an average of 152 a year. In 2007, the population decreased by 50 and in 2008 by another 34. South Dakota's Secretary of Corrections identified the 24/7 Sobriety project as part of the reason for these decreases.


Findings logo commentary For related Findings entries on 24/7 Sobriety and similar testing-based programmes see:
A new paradigm for long-term recovery
Setting the standard for recovery: physicians' health programs
Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE
Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders?
Analysis of South Dakota 24-7 Sobriety program data
South Dakota 24/7 Sobriety Program evaluation findings report

Last revised 14 March 2011

Comment on this entry
Back to contents list at top of page
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page and enter e-mail address to be alerted to new studies


Top 10 most closely related documents on this site. For more try a subject or free text search

Is 24/7 Sobriety a good goal for repeat driving under the influence (DUI) offenders? STUDY 2010

A new paradigm for long-term recovery REVIEW 2011

South Dakota 24/7 Sobriety program evaluation findings report STUDY 2010

Will intensive testing and sanctions displace treatment? DOCUMENT 2012

Will intensive testing and sanctions displace treatment? HOT TOPIC 2013

Analysis of South Dakota 24-7 Sobriety program data STUDY 2007

Managing drug involved probationers with swift and certain sanctions: evaluating Hawaii's HOPE STUDY 2009

The effect on reconviction of an intervention for drink-driving offenders in the community STUDY 2012

Drink-driving cut by 30-minute talk with hospital patients STUDY 2006

Summary of findings from two evaluations of Home Office alcohol arrest referral pilot schemes STUDY 2012



L10 Web Stats Reporter 3.15 LevelTen Hit Counter - Free PHP Web Analytics Script
LevelTen dallas web development firm - website design, flash, graphics & marketing